1995 Sidney Sax Medallist - Dr Rex Joyner

Dr Rex Joyner was born and educated in Queensland where he graduated in medicine from the University of Queensland in 1963. After completing internships and residencies in obstetrics and gynaecology and paediatrics he set up as a general practitioner in suburban Townsville where he gained valuable experience in the practice of medicine at the direct community face, gaining a deep insight into the health problems and expectations of the widest cross section of the Australian community. During this period, from 1966 73, he worked also in the Hospital Child Guidance Clinic, introducing classes and treatment programs for children and parents of the nuclear families affected by Townsville's isolation and its peculiar population structure. From 1974 76 Dr Joyner assumed the post of Medical Officer in Charge of the Community Health Service, an administrative role which involved the supervision of multidisciplinary teams associated with the health and welfare of the North Queensland community. This was to serve him well in his future career as a medical and health services manager.

His career aspirations brought Dr Joyner to Western Australia in 1976 to the position of Assistant Medical Superintendent at Royal Perth Hospital. In 1978 he was awarded a prestigious National Health & Medical Research Travelling Fellowship which took him to London to St Thomas' Hospital and to various centres throughout the UK where he studied particularly the application of computer systems in clinical and patient management and general hospital administration.

Dr Joyner returned to Royal Perth Hospital and in 1980 was seconded to the Department of Health & Medical Services to assist in policy and planning. He travelled extensively in Australia and to New Zealand on behalf of the Director and the then Minister of Health, contributing to many projects and initiatives. Late in 1980 he was appointed Medical Superintendent of Royal Perth Hospital, the executive position responsible directly to the Board for the administration and management of all clinical services of the State's largest teaching hospital. In this capacity he either chaired, or was a member of, all the major committees of the Hospital and served on numerous State committees. He visited organisations overseas to study developments, often at the invitation of major international bodies involved in health care.

In 1987 he was appointed Chief Executive Officer of Royal Perth Hospital, following wide advertising of the post, which resulted from the restructuring of the two positions of Hospital Administrator and Medical Superintendent to a single executive position responsible to the Board of Management. Dr Joyner's new post, with wide responsibilities, provided the opportunity for innovative measures in hospital management and clinical services and in the further development of RPH in teaching and research. Under his direction RPH has extended its outreach services and has enjoyed some success in the AHA's Outreach Award program.

As CEO of Western Australia's leading teaching hospital, Dr Joyner has exerted a major influence on the education and training of clinicians and the various health professional groups in the State's universities. This influence is always positive and has been the major factor in facilitating clinical access for their students at a time of rapid growth and development which has severely strained the ability of the Royal Perth and Royal Perth Rehabilitation hospitals to accommodate these needs.

Curtin University in 1994 awarded Dr Joyner the honorary degree of Doctor of Technology which is conferred for "distinguished performance in the application of knowledge within the chosen profession of the person concerned and contribution to the community and service of support to the community". Dr Joyner, by this award, joined a very select group which, in the health and medical field, includes the late Sir George Bedbrook who played a key role in the development of rehabilitation education and research at Curtin.

In recognition of Dr Joyner's management expertise and wide knowledge and experience of health services generally, the Minister of Health in 1988 appointed him as a protemp Commissioner of Health. In this role for a limited time he was involved in considerations of reforms in the State's health care system. These organisational reforms are now coming to fruition largely due to the personal efforts of Dr Joyner. In July 1992 he was appointed General Manager of the East Metropolitan Health Region to pilot one of three different organisational structures established in the greater Perth metropolitan area. It is a tribute to his management expertise and leadership that the system he established, in a remarkably short time, was selected, well prior to the completion of the comparative evaluation of the three structures, as the future organisation for all regions. The Minister, in reviewing the regional structure, decided not to proceed with the metropolitan area reorganisation but has moved to ensure that achievements in terms of a better articulated system developed by Dr Joyner will be retained. The Minister publicly and formally acknowledged Dr Joyner's excellent contribution towards the development of costeffective structures and mechanisms for WA's health system. Dr Joyner's contribution to the hospital and health services systems in Western Australia on the widest possible front from acute care services to communitybased health care is unmatched.

Examples of Dr Joyner's influence and achievements affecting the health of all Western Australians are numerous and span many activities. He was a prime mover in developing a unique service encompassing all metropolitan hospitals in a uniform computer system. He has been a strong proponent of relevant university studies in management for clinicians moving into administration positions. He has encouraged research and has played a major role in establishing the Royal Perth Hospital Medical Research Foundation which includes WA's first purpose built medical and health research facility. The first stage of what is developing into an excellent research facility was built without government funding and stands as a tribute to Dr Joyner's dedication to research.

His contribution to health sciences is also acknowledged by his appointment in 1993 to the Health Advisory Committee and also as Chairman of the Health and Medical Services Standing Committee of the National Health and Medical Research Council.

It is testimony to his management and leadership that Royal Perth Hospital in the national accreditation system has been widely acclaimed by external reviewers as one of, if not the, best managed hospitals in Australia and an exemplar of the highest quality in the provision of patient services.

Dr Joyner is one of the best known and highly respected medical and health administrators in Australia and his endeavours and achievements provide an excellent example of application of knowledge to professional practice and community service. He has served his professional associations in the highest executive positions as national councillor and senior vicepresident of the Royal Australian College of Medical Administrators and is a Fellow of a number of the medical colleges. Dr Joyner is a Surveyor for the hospital accreditation program of the Australian Council in Health Care Standards.

His foresight in hospital management led to Royal Perth Hospital's involvement in the National Program of Management Development for Clinicians being conducted by the Royal Australian College of Medical Administrators and the King's Fund College of London. The funding for this project is provided by the Commonwealth Department of Health. Royal Perth Hospital is one of two trial sites selected in Australia.

This project, which has been undertaken over the past eighteen months, has resulted in a complete restructuring of the Hospital's clinical service delivery from a departmental basis to a divisional structure based on disease categories.

The new structure is intended to ensure swift response to rapid changes occurring in the health system while maintaining high quality services, research and teaching. Importantly, this has enabled management responsibility to be devolved to clinicians so that they are better equipped to make management decisions affecting patient care.

Although only in its formative period, there has been considerable interest from within Australia and from overseas. Of particular interest is the involvement of the Hospital's most senior and respected clinicians and many of whom have accepted positions as Divisional Directors.

Dr Joyner's management skills are also well recognised outside of the health field. Since 1988 Dr Joyner has been a member of the Board of Directors of the Australian Institute of Management. In 1994 he was appointed State President after a serving a year as Vice President. The Institute is recognised as one of the Western Australia's leading management institutions.

In the international sphere he has consulted in China under the auspices of the Australia - China Council to develop programs in hospital management and medical technology. He has consulted in Indonesia on behalf of the health sector and a delegate of the Australian Institute of Management of which he is State President. His knowledge and experience has, led to an invitation to join the previous Minister for Health, Mr Peter Foss, and to explore cooperative opportunities in medical and health services. It is significant that in such projects, as well as on local issues, Dr Joyner is invariably the first person consulted by the Minister and the Commissioner.

In recognition of his capabilities, Dr Joyner was recently appointed to the parttime (3 sessions) position of Director of the WA Health Export Unit. This unit has been established by the Government to promote the State's health industry resources in South East Asia.

In this role he will accompany the present Minister, the Hon Graham Kierath MLA to Jakarta in October to attend a major exhibition of Australian health products and medical setvices for Indonesia.

Independent of this responsibility, RPH has also established formal links with three major hospitals in Indonesia through the signing of Memoranda of Understanding. Under these agreements the hospitals have agreed to work towards the "promotion of better relationships and quality of care to mutual benefit" through the transfer of knowledge, technology and technical assistance and the training of staff.

Dr Joyner's broad understanding of health and community issues was also recently acknowledged by his appointment in January 1995 to the Board of the WA Drug and Alcohol Authority.